11D0999802 CLIA NUMBER - DOUGLASVILLE NEPHROLOGY AND HTN CLINIC

Laboratory Demographics

  • CLIA Code: 11D0999802
  • Facility Name: DOUGLASVILLE NEPHROLOGY AND HTN CLINIC
  • Facility Address: 6488 SPRING STREET, SUITE 100
    DOUGLASVILLE, GA
    ZIP 30134
  • Facility Phone: 770 489-7978
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DOREEN SMALLS
  • NPI Number: 1073909198
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 11D0999802
LAB Type Physician Office
Facility Name DOUGLASVILLE NEPHROLOGY AND HTN CLINIC
Street 6488 SPRING STREET, SUITE 100
City DOUGLASVILLE
State GA
ZIP 30134
Phone 770 489-7978
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/23/2024
Certificate Expiration Date 5/22/2026
Facility Type Physician Office
Lab Director DOREEN SMALLS

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This page was last updated on: 6/4/2025